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"Saving the World"

By Fred Penzel, Ph.D.

I was recently reminded of a type of obsessive-compulsive disorder (OCD) known as "compulsive hoarding" when a patient brought me an article from a British newspaper that jokingly looked into the homes of several people afflicted with this problem. The reporter, in his ignorance, seemed to think it humorous that these homes were knee-deep in possessions, papers, broken or useless things, or just plain trash. Even in our own country, those who compulsively hoard and collect are sometimes kiddingly referred to as "pack rats," and they are laughed at as being eccentrics.

Unfortunately, compulsive hoarding is no joke. It can in fact be quite excruciating, just like any form of OCD. When you look closely at the lives of compulsive hoarders, there is no doubt that they can become incapacitated and disabled by their habits, and their lives frequently become disorganized and unmanageable. Their home lives can be rather isolated, and socializing is often a problem. They are unable to have visitors or even repairmen come into their homes, due to the serious embarrassment they would feel at having someone see the clutter.

Hoarders may collect large quantities of old newspapers and magazines, greeting cards, bottles, junk mail, plastic containers, broken appliances, old clothes, shoes, furniture, etc. They not only save broken and useless things, they also tend to save quantities of stuff that can greatly go beyond what a person could possibly ever need. This could include buying things such as soap or paper goods several cases at a time, or dozens of an item that might be on sale, but which most people would only own one of.

Typical symptoms of compulsive hoarding could include any or several of the following:

Making and keeping extensive lists or records of certain things, even after they are no longer needed

Saving large amounts of certain items for possible use by others or for future recycling

Actually, the urge to hoard and collect may well be strongly instinctive in many species. The familiar sights of squirrels storing seeds and acorns and birds gathering nesting materials tell us that humans are certainly not alone when it comes to collecting and saving. Among our fellow human beings, we can observe a whole range of such behaviors, both positive and negative. However, when it is expressed through OCD, it may be that an instinctive program we all carry in our brains has been inappropriately activated. This may resemble trichotillomania, where it has been theorized that grooming instincts are wrongly turned on.

I have observed that one of the main reasons for hoarding is this: a fear that if things are thrown away, they will almost certainly be needed one day, but will be gone for good. This loss will then lead to some kind of serious hardship or deprivation. This symptom is due to the chronic doubt which is a hallmark of OCD (it used to be known as 'The Doubting Diseasde' in the nineteenth century). Because of this, many hoarders seem to lack the ability to discriminate between what is truly useless and what isn't. Ironically, hoarders rarely use, much less look through, the things they save. Even when they do search through their piles and heaps, they are usually unable to find what they are looking for.

There are some who hoard for what seem like sentimental reasons they keep many or most of their old belongings. One adult patient of mine had all of her childhood toys, as well as all the clothes she had ever owned since she was a youngster. There may be a number of reasons behind such behavior. One may be superstitious bad luck may occur if they let go of any of these things. Another may be the previously mentioned fear of the loss of something needed one day. Such doubts may be further compounded if the individual is reluctant to grow up or has some reason for not wanting to give up or lose their past.

A different type of hoarding seems to relate more closely to the sort of hyperresponsible thinking often seen in OCD. Here, hoarders save things they believe will be useful to others rather than themselves. They would feel guilty and worry about being neglectful if they didn't have these things around for others who might need them someday. They may also feel guilty if they don't save a potentially useful item that could be repaired or recycled rather than discarded or wasted. In reality, no one ever really needs the things they save, and most of the things saved never get repaired or are too damaged to be fixed in any case. Being constantly reminded to save the environment and to be more green certainly doesn't help theswe individuals.

Some who appear to hoard actually don't save things for their own sake. Their obsessive doubts cause a fear that, when throwing trash away, something important will be thrown out with it by mistake. These people compulsively thumb through every page of newspapers or magazines, and they double-check the seams of paper bags, boxes, and envelopes to be certain they have not thrown out money, jewelry, or important papers. Throwing things out can involve hours of searching and checking. This can become so difficult and time-consuming, that they may eventually just stop throwing things away altogether: This type of saving may not really be true hoarding, but something more like a type of double-checking. I like to refer to it as pseudo-hoarding.

Compulsive hoarders can accumulate such large amounts of things that they create storage problems and fire hazards. In particular, huge stacks of papers, excessive furniture, old clothing, non-working appliances, etc., can quickly overwhelm a house or apartment. The range of items saved can include something potentially useful such as reusable containers, except that hoarders may have hundreds of them. The other end of the range may include such unlikely things as cigarette ashes, pet hairs, or used tissues. Entire rooms become completely unusable. I know of people who have been evicted or threatened with eviction due to the large amounts they have collected. Some hoarder's properties are declared to be public nuisances by their local governments. In such cases, the local authorities may conduct a cleanup on their own, and bill the unfortunate sufferer. Luckily, some towns and counties are becoming more educated about these problems, and are dealing with them in more humane ways. Local problems aren't the end of it. I also know of divorces resulting from a spouse refusing to live under such overwhelmingly disorganized conditions. I have seen hoarders threatened by state child protective services with the loss of their children when it was thought that unsafe or unsanitary living conditions were seen as a source of potential harm. Several years ago in our area, a case was reported of a woman who burned to death in a house filled with newspapers.

In the most extreme cases, homes can almost look as if they have been vandalized, with floors covered with debris and rooms filled to overflowing with boxes and bags full of possessions. The most famous example of a compulsive hoarder was Langley Collyer who, between 1933 and 1948, filled a mansion on Fifth Avenue in Manhattan with 120 tons of refuse, junk, and human waste. He would prowl the streets of Manhattan at night looking for items to rescue from the trash. Both he and his invalid brother, Homer, were found dead among possessions that included 11 pianos and all the components of a Model T Ford. Langley was actually crushed by a falling heap of heavy items he had rigged as a booby trap for burglars.

There are other types of hoarding, such as having to make a "complete" collection of a particular item to get a sense of "perfect" closure. There is "mental" hoarding, which is having to memorize all informa-tion on a particular topic. There is also the hoarding of memories or experiences. These symptoms seem to overlap with the problem of compulsive perfectionism. It is not unusual for some hoarders to buy and save large amounts of useful things that they then must maintain in a pristine and perfect condition. The items may be carefully wrapped, packaged, and stored away, never to be touched by anyone. Ironically, many of the saved items often deteriorate after years in storage, becoming totally unusable. Certain types of compulsive buying may be related to hoarding, depending upon what is done with the purchase.

Proper treatment for compulsive hoarding relies heavily on behavioral techniques. Hoarders need to be encouraged to gradually discard items that they find harder and harder to part with. A therapist may have to accomplish several goals: first, visit the home in order to survey the dimensions of the problem; second, determine the order in which things need to be tackled; and third, assist in the throwing-out process if the person can't seem to get started or is too great a procrastinator. I have sometimes encouraged people to begin by bringing bags of belongings to my office to start the discarding process.

Hoarders also need to be given guidelines for what is to be saved or discarded, now and in the future. We often use a "two-year rule." This states that if you haven't used it, worn it, or read it in the last two years, you don't need it. This obviously doesn't include valuables, heirlooms, or tools used only for special purposes. Some need even more specific rules. Most are discouraged from keeping more than the current week's newspapers or the latest issues of magazines, and articles are saved rather than entire issues. Mail must be sorted the day it arrives. Many also need help in organizing important personal papers and bills, and the purchase of filing cabinets is encouraged. In some cases, a therapist may also employ the services of a professional organizer to assist the sufferer in learning to manage their homes and possessions.

In serious cases, medication may help a sufferer approach the therapy process with less anxiety and fewer obsessional worries. It can also relieve serious depression that robs someone of the energy needed to clean house. The usual antidepressant drugs shown to help OCD are recommended. It is important to find a psychiatrist who is sympathetic and experienced in the treatment of OCD, which can take a certain amount of expertise to do properly.

With determination and support, hoarding can be conquered. I have seen people clean up some of the worst accumulations and keep them cleared up. There is no cure, however. In order to stay well, hoarders must learn to think differently and to keep up their new habits. Interestingly, upon recovering, the hoarder's reaction is often one of relief rather than anxiety. If this is your problem, get help. You don't have to drown in a sea of possessions and junk.

If you would like to read more about what Dr. Penzel has to say about OCD, take a look at his self-help book, "Obsessive-Compulsive Disorders: A Complete Guide to Getting Well and Staying Well," (Oxford University Press, 2000). You can learn more about it at www.ocdbook.com